super-healthy mortality...– firms such as vitality seeking to insure the super-healthy – annuity...
TRANSCRIPT
Super-healthy mortality How low can you go?
Dr Tim Crayford, Just. Plc Matthew Edwards, Willis Towers Watson
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Agenda – main concepts
Can we define a super-healthy group from the general population?
What is their mortality?
Does super-healthy mortality tell us anything about when longevity
improvements must stop?
12 June 2017 2
Who are the super-healthy?
13 June 2017
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Do actuaries like health?
Improvements
• Studies on improvements have generally been at the population level
• Over the last five or so years there has been increased interest in how improvements
vary by socio-economic strata
Base mortality
• Underwriting has generally also looked at broad groups, with segmentation focusing on
worse mortality rather than better
• This perspective is also starting to change
– firms such as Vitality seeking to insure the super-healthy
– annuity writers segmenting the (probably) very healthy using
postcode and annuity amount / final pensionable salary
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What can healthy lives tell us?
Base mortality
• What can a firm underwriting the healthiest lives safely assume?
Improvements
• Almost all (re)insurers and pension funds assume a constant long-term future
improvement rate in projecting longevity improvements (typically 1.25-1.75%)
• What does this imply for our understanding of average life expectancy?
• Is it reasonable for an average person now to become ‘as if’ super healthy
today at some future point?
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The wisdom of crowds: what does Google tell us?
19 June 2017 6
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Objectives of the improvement analysis
• Construct a life table of annual mortality by age for males with no
significant current recorded conditions, no significant medical history,
and no significant medication history from ages 40+
• Explore the rate at which population mortality would have to improve
before all individuals in the general population experienced the
mortality currently experienced by this group
• Compare this rate to the assumptions typically used by insurers (etc)
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Clinical Practice Research Database
• Comprises medical treatment information on 21 million anonymised patient
lives followed for up to 25 years
• 1.8bn consultations
• 1:12 people in UK
• 600 currently contributing GP practices
• Medical history mostly captured, risk-factors less so
• Data quality varies by time (some lack of consistency pre-2010)
Base mortality
13 June 2017
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Methodology
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Multistate model mechanics
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A healthy hypothesis
• The presence of disease in an adult is clearly a risk factor for mortality
• Adults in the general population with no relevant history recorded in their GPs’ medical records are likely to be drawn from the healthiest group of people alive today
• Those adults will differ in terms of their risk factors for mortality, so the group will not necessarily be homogeneous
– In GPs’ records, most smokers will have this fact recorded, as will be most people’s height / weight
– Although other lifestyle predictors of longevity, e.g. diet / exercise, not recorded systematically
– These adults may also differ in diseases that are not recorded in their medical notes
• We can study lives consisting of ‘undiseased’ non-smokers with other good risk factors
• For what reasons should people living (say) 100 years from now, who do not have, and have never had, any significant medical history, be living any longer than adults in this group who are alive today?
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Selection criteria for our super-healthy group
• Absence of
– Heart disease, stroke
– Diabetes
– Cancer
– Respiratory disease
– Neurological disease
– Other major conditions
(eg IBD, kidney disease)
• NB we also mean absence of
any history of these conditions
• Presence of
– Good HbA1c
– Good BMI
– Good socio-economic bracket (via ONS IMD)
– Good smoking habit (ie never-smoker!)
Data volumes: 676,000 man-years exposure from disease
criteria, pre-risk factor stratification. Risk factor effects
computed from larger data set using GLMs rather than
cutting data to create individual ‘cells’.
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Healthy mortality
We can compare the mortality of
the healthy group against
population, and also against typical
enhanced annuity profile. The
relative ‘health discount’ varies
from -75% initially to circa -20%
from age 75.
Also as a lower bound we have a
‘permanently healthy’ life – defined
as not having any major conditions
at the start of each year
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Select effects
Method can be used to compare the
mortality of males of identical age,
one of whom was known to be
healthy at age 60, the other was
known to be
healthy at age 50.
The graph shows mortality of the
‘just underwritten’ life in black
relative to the same life known to be
healthy 10 years previously.
The length of the select period is
surprising to actuaries used to the 2
or 5 yr select periods of CMI tables.
0
0.2
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0.6
0.8
1
1.2
60 65 70 75 80 85 90
Relative 'select effect'
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Healthy mortality – comparison from US
21 June 2017 16
0
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0.07
40 42 44 46 48 50 52 54 56 58 60 62 64 66 68 70 72 74 76 78
Superhealthy mortality in US v population (2008 males)
Population TOAMS super-healthy
Data from Towers Watson
Old Age Mortality Study 3,
looking at non-smoking
preferred lives with highest
sums assured.
Mortality = 30% of
population initially, rising to
around 50% age 79.
Context to analysis
21 June 2017
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Jim Vaupel: Broken limits to life expectancy 2002
21 June 2017 18
Oppen & Vaupel
Science, 2002
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In Search of Methuselah:
Estimating the Upper Limits to
Human Longevity
Olshansky et al
Science 1990
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Dong Nature 2016
21 June 2017 20
Average age at death for 554
supercentenarians 1970-2005
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ELT17, the super-healthy table and
convergence
How low can you go?
12 June 2017
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Aim of this section
• Take the CPRD-derived life-table of annual mortality by age for males with no
significant current recorded conditions, no significant medical history, and
good risk factors (non-smokers etc. as per previous slides) from ages 40+
• Explore the rate at which population mortality (ELT17) would have to improve
before all individuals in the general population experienced the mortality
currently experienced by this group
• Compare this rate with typical insurer improvement assumptions
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Cohort ALE from
65 for always
healthy from 2017
under various
long-term
improvement
assumptions
21 June 2017 27
80
85
90
95
100
105
110
0 0.5 1 1.5 2 2.5 3 3.5 4
Co
ho
t A
LE
Annual Improvement Rate
2017
Synthetic
Healthiest
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Cohort ALE from
65 for always
healthy from 2067
under various
long-term
improvement
assumptions
21 June 2017 28
80
85
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105
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0 0.5 1 1.5 2 2.5 3 3.5 4
Co
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LE
Annual Improvement Rate
+50 years: 2067
2017
healthiest
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Cohort ALE
from 65 for
always healthy
from 2117 under
various long-
term
improvement
assumptions
21 June 2017 29
80
85
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0 0.5 1 1.5 2 2.5 3 3.5 4
Co
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Annual Improvement Rate
+100 years: 2117
2017
healthiest
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CMI Convergence to synthetic healthiest @ 1.5%
21 June 2017 30
Year when CMI model converges to healthiest 2126
Healthiest LE from CPRD 93.8
Years after 2017 when rates converge 109
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Lu et al – improvements by SEG
21 June 2017 31
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Caveat: generalisability of population improvements to
healthy people?
• CMI suggestive evidence of increased improvements for normal health vs ill-
health retirees
• L&G / Barnet Waddingham / Hymans analysis showing higher improvement
rates amongst people in higher SEGs
• Suggests that the healthiest people have experienced the highest
improvement rates – some assume up to 5% in recent years
• Can this be sustained? Will we see a widening of the longevity inequality
21 June 2017 32
Reductions in which diseases? Drivers of reductions in longevity
12 June 2017
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R238 G116 29 21 June 2017 34
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
4.0%
1985 1990 1995 2000 2005 2010 2015
Actual CMI_2016Males
Average
annual
improvement
rate over
previous 5
years, 1925-45
birth cohort,
England &
Wales
With thanks to Richard Willets
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Cause-specific improvements UK 1983-2013
21 June 2017 35
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Obesity
21 June 2017 36 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/
613532/obes-phys-acti-diet-eng-2017-rep.pdf
• Obesity continues to rise
• Seems relatively constant
across socio-economic
groups for males
• What would have to happen
for people to reverse the
trend?
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Alcohol – probably getting better?
• UK alcohol-related deaths have been broadly static in the last two years of reporting (2013 and 2014
compared with 2012), and circa 10% down from peak 2008 levels.
• Overall the age-standardised mortality rate is around 50% higher in 2014 than it was twenty years
previously.
Trends and considerations
• According to the ONS, researching drinking frequency from 2005-2013:
– %age of the population having one alcoholic drink in the previous week fell by around 10% (relative), from 64% to 58%;
– %age of the population having an alcoholic drink in at least five days in the previous week fell by around one-third, from
17% to 11%.
• But … share prices of the drinks sector have increased by 30% over the last three years (end Jan
2014 to end Jan 2017), around three times the FTSE-100 increase – could imply
a very positive outlook for ongoing future demand?
12 June 2017 37
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UK Leading Causes of male death 65-79 2014
21 June 2017 38
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
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UK Leading Causes of male death 65-79 2014
21 June 2017 39
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
39.7% “small signs of improvement”
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UK Leading Causes of male death 80+ 2014
21 June 2017 40
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
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UK Leading Causes of male death 80+ 2014
21 June 2017 41
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
44.7% “small signs of improvement”
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Increase in LE with elimination of Diabetes and all CVD
21 June 2017 42
Age Population LE New L.E. Difference Increase
40 44.00 45.62 1.62 3.7%
50 34.98 36.33 1.35 3.8%
60 26.43 27.52 1.09 4.1%
70 18.53 19.37 0.84 4.5%
80 11.64 12.22 0.58 5.0%
Pulse Model: what would happen to period LE in the average CPRD
population with the removal of two major sources of disease?
*Period LE is clearly absent of any assumed improvements
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So what is the healthiest ALE in CPRD?
• Highly synthetic group
• 92.86 at 40 years
• 93.81 at 65 years
• These people have no observable illness at the start of the year, they
experience a certain amount of incident disease, and some of them die within
this calendar year. This implies the elimination of chronic diseases and the
removal of existing medical history from all people at 65 years
• Their rates of death are typically around 20% of the ELT17 table, increasing
from the mid-eighties.
21 June 2017 43
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Average annual
improvement
required for
population ALE
to reach 93.8
years
21 June 2017 44
2000
2100
2200
2300
2400
2500
2600
2700
0 1 2 3 4 5 6
Year
when A
LE
at
65 >
93.8
years
Annual Improvement Rate (%)
Assumes improvements
tapering from 85-110 years
Long-term rate as low
as 1.25% is sufficient to
reduce mortality of
everyone to current
healthiest within 100
years
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Lu et al – improvements by SEG
21 June 2017 45
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What could change for the very healthiest?
• Future incidence of disease?
• Obesity, Diabetes?
• Early uptake of longevity-
promoting drugs by the highest
social classes?
– Statins, LDL Vaccine?
– Metformin?
– New pharmaceuticals?
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By how much would mortality need to be reduced in the
future to take average longevity to…
21 June 2017 47
Average age
of death
100 Yrs 120 Yrs
Super-healthy -50% -87%
Population -90% -99%
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Conclusions
• Maximum ALE in identifiable current UK populations is 93.8 years (male)
• The population as a whole could reach this level within 100 years at typical
industry-standard assumptions
• There has been a significant down-turn in improvements in the UK. It is
uncertain both as to the cause and as to whether this will be sustained
• Is it reasonable for projections not to assert a research-based assumption of
maximum longevity?
• In other words: should we move from the idea of a constant LTR to a gradually
decreasing LTR – especially for deferred pension liabilities?
(NB different from tapering > age 85)